Increasing Medicare coverage could lower healthcare costs

The United States spends twice as much on health care as most other modern nations, with less to show for it in terms of longevity and other true measures of health. The reasons why — and what we could and should do about it — make the March 4 edition of TIME probably the most important single issue of any magazine ever published.

Steven Brill’s cover story, “Why Medical Bills Are Killing Us,” takes up nearly the entire edition. Anyone who cares about this — and who doesn’t — needs to buy or borrow the magazine now or download the article from TIME’s website. It’s a keeper.

The big villains in Brill’s piece are the hospitals whose outrageous bills have nothing at all to do with what their itemized services cost them, profiteering by pharmaceutical companies and the manufacturers of artificial hips and other durable medical supplies, and a Congress that protects them.

Since 1998, the health care industry has spent $5.36-billion — that’s money extracted from you on me — on lobbying Congress. Defense contractors, by contrast, invested a mere $1.53 billion in feathering their nests.

There’s something frightfully wrong with a system that allows the CEOs of nonprofit hospitals to be compensated as much as $5.9-million a year, while it hounds strapped-out patients — even many with insurance — into despair or bankruptcy. It is beyond bizarre that those lacking insurance, who are least able to pay, are slammed with the highest bills.

“Unless you are protected by Medicare,” Brill writes, “the health care market is not a market at all. It’s a crapshoot.” Patients have little to no informed choice of providers or treatments, a situation bound to get worse as hospitals apply their profits to swallowing up their competitors and making employees of previously independent physicians. Patients, he says, “have no choice of the drugs that they have to buy or the lab tests or CT scans that they have to get, and they would not know what to do if they have a choice. They are powerless buyers in a seller’s market where the only sure thing is the profit of the sellers.”

The big hero in all this is Medicare. It administers claims far more efficiently than private insurers and has made a science out of paying hospitals only what it actually costs them, including salaries and other overhead, to do what they do.

Brill’s research makes a powerful case for lowering — not raising — the age of Medicare eligibility, provided that people nearing 65 pay higher premiums or co-pays. He concedes that hospitals need more lawsuit protection if they are to stop performing so many costly scans and lab tests.

Brill estimates that the U.S. pays $750 billion too much on health care every year, compared to other developed nations. He warns that it will get worse, under the new coverages rightfully mandated by Obamacare, unless the nation deals with the profiteering and other treatable causes.

No summary as short as this can do justice to a report as magisterial as the March 4 TIME, but I hope this encourages readers to go to the source. We’ve been powerless buyers far too long.